Evaluating the safety of glucagon-like peptide-1 agonist use in non-diabetic overweight patients undergoing shoulder arthroplasty
- Design
- Retrospective cohort · 4839 participants · Hard outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all patients had obesity (BMI ≥ 30 kg/m2) and were undergoing shoulder arthroplasty; people with diabetes were excluded.
- Could weight loss explain it?
- PossiblyPossibly: no weight change, HbA1c or mediation analysis is reported, so weight and metabolic change are not separated from a drug effect (the evidence model's default); matching on age, sex, Elixhauser Comorbidity Index, smoking status and comorbidities addresses confounding, not mediation.
- Study tier
- Study tier 3LOW: a single observational database cohort with matching; confounding by indication is possible and the drugs and doses are not specified.
- Assessment
- Version 4 · Two reviewers differed; settled by a recorded ruling · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
In a database of people with obesity but no diabetes having shoulder replacement between 2010 and 2023, 462 GLP-1 users were compared with 4,377 matched non-users. GLP-1 use was linked to more readmissions (odds ratio 2.034) and more overall complications (odds ratio 1.474) within 90 days, but not to differences in the other 90-day outcomes or in 2-year infection, fracture or revision. As an observational study, it shows associations, not cause.
01Findings
What the study reported
- Drugs
- Glp-1 receptor agonists
- Dose
- various
- Comparator
- matched obese GLP-1 non-users
- Primary outcome
- 90-day and 2-year outcomes after shoulder arthroplasty (readmission, overall complications, prosthetic joint infection, fracture, all-cause revision)
- Effect
- 90-day readmission OR 2.034 and overall complications OR 1.474, both higher in GLP-1 users; no differences in the remaining 90-day outcomes or in any 2-year outcome (prosthetic joint infection, fracture, all-cause revision)
- 95% confidence interval
- 95% confidence interval: 1.594-2.578 (readmission)
- P value
- P < .001
- Follow-up
- 90 days and 2 years
- Adverse events
- Higher 90-day readmission (OR 2.034) and overall complications (OR 1.474) among GLP-1 users; no difference in 2-year prosthetic joint infection, fracture or all-cause revision.
- Limitations
- Retrospective database study with matching rather than randomisation, so residual confounding is possible; the specific drugs, doses and duration of use are not given in the abstract.
Who was studied
- Bmi min
- 30
- Obesity status
- obesity required (BMI ≥ 30 kg/m2)
- Diabetes status
- excluded
- Cvd status
- not reported in abstract
- Ckd status
- not reported in abstract
- Baseline condition
- anatomic or reverse total shoulder arthroplasty
- Sample size
- 4839
- Inclusion exclusion
- TSA patients with BMI ≥ 30 kg/m2 and GLP-1 use within 3 months of surgery (users); history of diabetes and TSA for cancer, infection or pathologic fracture excluded
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 4839
- Randomization
- no
- Blinding
- n/a
- Comparator
- matched obese GLP-1 non-users
- Follow up duration
- 90 days and 2 years
- Outcome type
- hard
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- CI reported: 95% confidence interval: 1.594-2.578 (readmission)
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- not reported in abstract
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[BACKGROUND] Initially indicated for diabetes mellitus (DM), glucagon-like peptide 1 (GLP-1) agonists are now indicated for obesity management in isolation of DM. While prior studies have examined post-operative outcomes after total shoulder arthroplasty (TSA) in GLP-1 users with DM, there is a paucity of literature evaluating its use in non-diabetic patients for weight loss rather than glucose control. Therefore, our analysis compared 90-day and 2-year outcomes following TSA between non-diabetic obese GLP-1 users and a matched cohort of obese GLP-1 non-users. [METHODS] The PearlDiver Mariner database was queried to identify patients who underwent anatomic TSA and reverse TSA between 2010 and 2023. Patients with a history of DM or who underwent TSA for cancer, infection, or pathologic fractures were excluded. Patients with a body mass index ≥ 30 kg/m2 within 6 months of surgery were included. GLP-1 users (within 3 months of surgery) were matched in a 1:10 ratio to GLP-1 non-users by age, sex, Elixhauser Comorbidity Index, smoking status, and various comorbidities. Multivariate logistic regression models were utilized to compare outcomes at 90 days and 2 years. [RESULTS] After matching, 462 GLP-1 users and 4,377 GLP-1 non-users were included in our analysis. GLP-1 users had higher readmission rates (odds ratio: 2.034; 95% confidence interval: 1.594-2.578; P < .001) and subsequently overall complication rates (odds ratio: 1.474; 95% confidence interval: 1.295-1.799; P < .001) compared to GLP-1 non-users at 90 days. However, no differences were seen between cohorts for the remaining 90-day outcomes nor for all evaluated 2-year outcomes including prosthetic joint infection, fracture, and all-cause revision. [DISCUSSION] Our analysis found a higher incidence of overall complications at 90 days among obese, non-diabetic GLP-1 users, driven largely by an increased incidence of readmissions. However, there were largely comparable outcomes at 2 years. These findings suggest that while GLP-1 agonists may be reasonable to use in the perioperative period, interventions to reduce readmissions among these patients may be warranted.